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MED GAS > FINAL REVIEW > Flashcards

FINAL REVIEW Flashcards

1
Q

What are the characteristics of oxygen?

A

Non-flammable, oxidizing and supports combustion
Colorless, tasteless, transparent and odorless

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2
Q

What are the advantages to storing O2 in liquid form vs gas?

A

Liquid has more storage capacity and is more convenient. Also its less hazardous and operates at a lower pressure. No regulator is needed

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3
Q

What are the different Heliox mixtures and their dilution factors?

A

80/20 - 1.8
70/30 - 1.6

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4
Q

What does the DOT stand for and what do they do?

A

Department of Transportation- they regulate manufacturing and filling and do hydrostatic testing every 5-10 years

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5
Q

What does the CGA stand for and what do they do?

A

Compressed Gas Association- they regulate storage and safety and color codes

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6
Q

What does the NFPA stand for and what do they do?

A

National Fire Prevention Agency- they regulate bulk O2 systems

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7
Q

What are the DOT fabrication markings mean? (3A, 3AA, and 3M)

A

3A- Carbon steel
3AA- Steel alloy
3M- Aluminum

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8
Q

How often are safety tests performed for medical gas cylinders?

A

Every 5-10 years

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9
Q

What does EE- (followed by a number) stand for on a gas cylinder?

A

Elastic expansion

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10
Q

What does * (next to a date) stand for on a gas cylinder?

A

This indicates DOT approval for 10 year testing

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11
Q

What does + mean on a gas cylinder?

A

This means the cylinder can be filled 10% above service pressure

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12
Q

What type of tanks CANNOT be overfilled?

A

Aluminum

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13
Q

What is a frangible disk?

A

A safety feature on a gas cylinder that ruptures at 3000 psi

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14
Q

What is a fusible plug and what type of tanks are they common on?

A

It is a safety feature on a gas cylinder that melts at 170 degrees C (on most small cylinders)

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15
Q

What safety feature is on most large cylinders?

A

Spring loaded- opens and vents gas at set high pressures

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16
Q

What does PISS stand for and what type of tanks?

A

Pin Index Safety System and it is for small cylinders

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17
Q

What does ASSS stand for and what type of tanks?

A

American Standard Safety System and it is for larger cylinders (threaded)

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18
Q

What does DISS stand for and what type of tanks?

A

Diameter Index Safety System and it is for low flow gas connectors like in the wall at hospitals (Quick Connect)

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19
Q

What type of medical cylinder is green? Brown? Yellow?

A

Green- Oxygen
Brown- Helium
Yellow- Air

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20
Q

How do you measure gas filled cylinders vs liquid cylinders?

A

Gas- a full tank is 2200 and it is directly proportional to its pressure (psi)
Liquid- weight

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21
Q

What are the conversion factors for E, G and H tanks?

A

E- .28
G- 2.41
H- 3.14

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22
Q

What are the 3 types of flow meters?

A

Flow restrictor
Bourdon gauge
Thorpe tube

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23
Q

In what situation is the Bourdon Gauge a good option and why? What does the Bourdon gauge measure?

A

It is great for transport and can be used in any position (laying down). It measures pressure, not flow

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24
Q

What happens when the Bourdon Gauge has back pressure?

A

The reading stays the same and yet the patient is getting less than what the gauge says.

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25
Q

What type of orifice and pressure does the Bourdon gauge and Thorpe tube use?

A

Bourdon gauge - fixed orifice and adjustable pressure reducing valve
Thorpe tube- flow variable orifice and constant pressure device (always 50 psi)

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26
Q

What are the 2 types of Thorpe tubes available and in what situation is it not ideal?

A

Uncompensated and compensated and it is not ideal for transport because it is only accurate in an upright position

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27
Q

What does increasing the size of the tube do to the gas flow?

A

Increases it

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28
Q

What is the difference between a compensated and uncompensated Thorpe tube?

A

Uncompensated shows flow lower than actually delivered to patient if there is a kink and compensated is not affected by back pressure and reads actual flow going to patient

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29
Q

How do we know if we are using a compensated Thorpe tube when we plug it into the wall?

A

The ball will jump up and fall back down

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30
Q

What is a regulator?

A

A pressure reducing valve and flow meter together (high pressure gas cylinders need them)

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31
Q

Why do we crack the tank before using?

A

The clear out dust and debris
The prevent damage to the regulator

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32
Q

What type of bulk system do most large facilities use?

A

Liquid bulk

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33
Q

What are zone valves used for and how do we turn them off?

A

They are used for maintenance and in case of fire. We can turn them off one section at a time

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34
Q

What is the overall goal of oxygen therapy?

A

Maintain adequate tissue oxygenation while minimizing cardiopulmonary work (reduce the work on the heart)

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35
Q

What are the normal adults values of PaO2 and SpO2?

A

PaO2 - 80-100 mmHg (ABG)
SpO2 - 95-99% on room air

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36
Q

Does oxygen treat breathlessness and can we have too much oxygen?

A

Oxygen doesn’t treat breathlessness, only hypoxia, and we can have too much oxygen

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37
Q

What are some symptoms of oxygen toxicity?

A

Vasoconstriction and decreased cardiac output (PaO2 > 300 mmHg)

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38
Q

What is depression of ventilation and who is affected by this?

A

Decrease in ventilation of about 20% and COPD patients (patients get lethargic and confused)

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39
Q

What is retinopathy of prematurity and who is affected?

A

Abnormal eye condition in premature and low birth rate babies who receive supplemental O2, can lead to blindness

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40
Q

What is fixed vs. variable FiO2?

A

Fixed- system provides all of the patients inspired gas
Variable- system only provides some of the inspired gas and the patient must draw (or entrain) the remainder from surrounding air

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41
Q

What are the 3 types of oxygen therapy designs and are each one variable or fixed?

A

Low flow (variable), high flow (fixed) and reservoir (variable)

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42
Q

What are the different types of low flow systems and what L/m are they prescribed at?

A

Nasal cannula, nasal catheter and transtracheal catheter
8 L/m or less

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43
Q

What flow rates are used with a nasal cannula and what FiO2 is delivered? When do we use a humidifier?

A

1 L/m = 24%
2 L/m = 28%
3 L/m = 32%
4 L/m = 36%
5 L/m = 40%
6 L/m = 44%
>4L/m

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44
Q

What are some safety hazards for oxygen and what does NOT affect safety?

A

Smoking, Vaseline, electronics
Lead- based products DO NOT affect

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45
Q

What are advantages of high and low flow devices?

A

High flow guarantees the patients needs and low flow has an ease of use (comfortable, eating, moving around)

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46
Q

What is the best way to identify what gas is in a tank?

A

Label

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47
Q

What is the difference between hypoxia and hypoxemia?

A

Hypoxia- low level of oxygen in the tissue
Hypoxemia- low level of oxygen in the blood

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48
Q

What is a reservoir system and what types are there?

A

Incorporates a mechanism for gathering and storing O2 between breaths to draw extra flow from when their inspiratory flow exceeds the flow coming from device
Reservoir cannulas, masks and non-rebreathing circuits

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49
Q

What are the most commonly used reservoir systems and what are the three types?

A

Simple masks, partial rebreathing mask and nonrebreathing mask (all low flow)

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50
Q

What is the L/m used with a simple mask (and %) and what is the most common hazard?

A

5-10 L/m (35-50%)
Must be used with a minimum of 5 L/m
Aspiration

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51
Q

What FiO2 does the partial rebreather deliver and are there valves? What does flow rate start at?

A

40-70%, no valves, 10L/m

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52
Q

What FiO2 does the non rebreather deliver and how many valves?

A

60-80% with 2 valves
90-100% with 3 valves
10L/m and adjust so that bag doesn’t collapse

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53
Q

In rebreathers and non-rebreathers, how is the flow rate and % ordered?

A

By the name of device

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54
Q

When is a non rebreather (one with the bag) indicated?

A

Emergencies and when delivering Heliox

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55
Q

When do we use High Flow vs. Low Flow?

A

High flow is used if breathing pattern is erratic or the RR > 25. We use low flow when the tidal volume is 300-700 ml and they have a normal RR and breathing pattern

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56
Q

What are high flow devices?

A

Air entrainment mask, air entrainment nebulizer, high flow nasal cannula (HFNC) and blending systems

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57
Q

What L/m qualify a device as a high flow?

A

60 L/m

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58
Q

What is the Venturi/ Bernoulli/ Air entrainment principle?

A

The velocity of the fluid increases as it flows through the narrower tube while the pressure decreases, due to conservation of energy.

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59
Q

How is the liter flow determined by an air-entrainment mask?

A

Liter flow is determined by the manufacturer

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60
Q

In air entrainment mask, what does changing the flow meter setting do to the flow and FiO2?

A

It alters the output flow but has little effect on set FiO2

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61
Q

What percentage of oxygen does the air entrainment mask provide?

A

24-50%

62
Q

What happens when more air is entrained in a mask?

A

Total output flow is increased but the delivered O2 is decreased

63
Q

Difference between high flow and low flow systems?

A

High flow is guaranteed to meet the patients need

64
Q

In a low flow system, what happens when the patient is shallow breathing?

A

The oxygen percentage will increase

65
Q

In a low flow system, what happens when the patient is breathing fast and heavy?

A

The oxygen concentration will decrease

66
Q

The bigger the port size…

A

The more air and the less oxygen

67
Q

The smaller the port size…

A

The less air and the more oxygen

68
Q

What range of flow and FiO2 does the high flow nasal cannula provide?

A

Flow- 30-60 L/m
FiO2- 21-100%

69
Q

What 3 components do HFNCs require?

A

A patient interface (nasal prongs or nasal cannula), a gas delivery device that regulates FiO2 and a humidifier

70
Q

In what situations do we use a simple O2 mask? What flowrate and O2 %?

A

We use this short term, for mouth breathers or for surgery.
Flowrate- 5-10 L/m
O2 %- 35-50%

71
Q

In what situations do we use a partial rebreathing mask or a non-rebreathing mask? What flow rate and O2 %?

A

We use this for traumatic injuries, smoke inhalation, MVAs (not for long term use)
Flow rate- min 10 L/m
Partial O2 %- 40-70%
Non-Rebreather O2%
w/ 1 side valve- 60-80%
w/ 2 side valve 90-100%

72
Q

In what situations do we use a air-entrainment mask (Venturi)? What flow rate and O2%?

A

We use this when we need an exact oxygen concentration.
Flow rate- 4-12 L/m (based on manufacturer)
O2%- 24-50%

73
Q

What are the 3 P’s?

A

We use this when selecting a device
Purpose
Patient
Performance

74
Q

When do we use a blending system?

A

When air entrainment can’t provide a high enough gas concentration or flow (when we need an EXACT concentration)

75
Q

What would we use an oxyhood for and what needs used in conjunction with this?

A

They are used for infants and need analyzed close to the babies face for accurate O2 %
Use with WICK humidifier

76
Q

What would we use a mist tent for?

A

A child but frequent analyzing needed from the opening of the tent

77
Q

What are some indications for hyperbaric oxygen therapy?

A

Carbon monoxide poisoning, wound healing, decompression sickness

78
Q

What is one of the benefits of nitric oxide therapy ?

A

Lowers pulmonary hypertension

79
Q

What are some benefits of heliox therapy?

A

Decreased RR, level of dyspnea and need for intubation for patients with croup, stridor, etc.

80
Q

What is the definition of humidity?

A

Water in a vaporous or molecular form

81
Q

What is absolute humidity?

A

the amount of water in a given volume of gas (expressed in mg/L)

82
Q

What is relative humidity?

A

the ratio of actual water vapor content to its saturated capacity at a given temperature (expressed in percentage)

83
Q

Air that is fully saturated with water vapor (100%) at 37 degrees C and 760 mmHg barometric pressure has water vapor pressure of ______ and absolute humidity of ______

A

water vapor pressure of 47 mmHg
absolute humidity of 44 mg/L

84
Q

What is humidity deficit?

A

amount of water vapor that the body must add to a gas in order to achieve 100% humidity at a body temp

85
Q

Explain gas flowing through a tube, what happens in relation to temperature and condensation.

A

Room air causes condensation to occur. Since the temperature of the room air is cooler, vapor will turn back into liquid.

86
Q

Providing inadequate humidity to a patient can result in what?

A

Atelectasis or pneumonia due to retained secretions

87
Q

What is the effect of water in the tubing?

A

Concentration of gas will increase due to less air mixing with it
Flow will decrease due to less room available for air to go through

88
Q

How can we eliminate condensation in tubing?

A

Water drainage bag or draining tubing

89
Q

What does a humidifier do?

A

Adds molecular water to gas

90
Q

What are the 3 types of active humidifiers?

A

Bubble
Passover (reservoir) - WICK
Vaporizer

91
Q

When do we use a bubble humidifier and do we heat it?

A

For flows greater than or equal to 4 L/m and it typically isn’t heated

92
Q

When do we use a tandem set up?

A

If the desired O2 is >60% to assure that the total flow meets or exceeds patient’s peak inspiratory flow needs

93
Q

What should the total flow be on a tandem set up?

A

Greater than or equal to 3 times the minute volume (generally 40-60 L/m)

94
Q

What will low water levels do to a humidifier?

A

Decrease the efficiency of the humidifier

95
Q

What do we need to do to assure the effective set up of a humidifier?

A

Occlude or pinch the tubing and listen for a chirp

96
Q

What do we use the Passover type humidifier for?

A

Used with mechanical ventilator, CPAP and high flow nasal cannula

97
Q

What are three types of Passover humidifiers?

A

Simple reservoir, Wick and membrane

98
Q

What is the best type of humidifier in most (if not all) situations?

A

WICK- provides 100% humidity

99
Q

What does HME stand for and what does it do?

A

Heat moisture exchangers and it is an “artificial nose” and ideal for patient transport, short term vent use or short term surgery

100
Q

When should we NOT use an HME?

A

With thick or bloody secretions or a high minute volume

101
Q

What is the role of a diffuser in a bubble humidifier?

A

The diffuser tube exposes the gas to the water and makes the bubbles

102
Q

What is the difference between humidity and aerosol?

A

Humidity is just moisturized air, not actual particles. Aerosol is particles suspended in gas (bland aerosol, meds, etc)

103
Q

What are goals of bland aerosol therapy and how do we receive this therapy?

A

Relieve bronchospasms, thin mucus, humidify respiratory tract and administer drugs
Through a nebulizer

104
Q

What is the biggest hazard of aerosol therapy?

A

Pseudomonos

105
Q

What is an USN used frequently for? What is the device powered by?

A

Used frequently for sputum induction and it uses a piezoelectric crystal

106
Q

What are the 4 different airway appliances that can be used with a LVN?

A

Aerosol mask, face tent, t-tube or trach mask

107
Q

What do we need to heat a bypassed airway to and why?

A

37 degrees C to prevent burns

108
Q

What does it mean when the mist is disappearing on inspiration with an aerosol set up? What do we do to fix it?

A

This indicates that the patient isn’t getting enough flow. We would increase the flow, add a tube, or add a tandem

109
Q

How does the O2 concentration affect the density and flow?

A

Higher O2 concentration- less total flow and more dense
Lower O2 concentration- more total flow and less dense

110
Q

What is the best way to confirm patient is getting adequate aerosol?

A

Watch mist coming out of tubing on inspiration

111
Q

What do we do if aerosol is produced in short puffs?

A

Drain the tubing of condensation

112
Q

What equipment is needed for application of a trach collar or T Tube?

A

Nebulizer, device being used (mask, face tent, etc.), thermometer, water collection bag, O2 analyzer and heater
*Also tandem set up if over >60%

113
Q

When using blender to get desired FiO2 with LVN what do we set the blender and air entrainment port to?

A

Set blender to desired FiO2 and set port to 100%

114
Q

What is a baffle and what is its purpose?

A

Anything inside the device and its purpose is to take away the large particles

115
Q

What do we use a bleed in for?

A

To get the exact concentration when we are unable to get desired concentration with a nebulizer alone

116
Q

What device would we use with upper airway swelling (subglottic edema)?

A

Cool aerosol LVN

117
Q

What device would we use when our patient has hypothermia?

A

Heated aerosol or humidifier

118
Q

What device would we use to hydrate excessive secretions?

A

LVN or USN

119
Q

What are the indications for Home O2 prescription? (PaO2 and SpO2)

A

PaO2 - < 55 mmHg
SpO2 - < 88%

120
Q

How do we assess our PaO2, SaO2 and SpO2?

A

PaO2 - ABG
SaO2 - ABG
SpO2 - pulse ox

121
Q

How can you determine oxygen toxicity?

A

PaO2 and exposure time

122
Q

What are the physical responses of oxygen toxicity?

A

Substernal chest pain, coughing, restlessness, hypertrophy, decreased lung compliance, decreased lung surfactant, etc.

123
Q

How do we administer oxygen to avoid oxygen toxicity?

A

Lowest possible FiO2 (maintain FiO2 below 50-60%) but DON’T withhold oxygen if needed

124
Q

Who does depression of ventilation effect and how? What is one way we can avoid depression of ventilation?

A

It affects a very small percentage of COPD patients when breathing moderate to high O2 concentrations
Use lowest flow possible with COPD patients

125
Q

What are the signs of depression of ventilation?

A

Confused, lethargic, decreased RR, decreased chest expansion

126
Q

Is hypoventilation typical in COPD patients?

A

No, so O2 to avoid hypoxemia should always be a priority

127
Q

Do we measure FiO2 or PaO2 to determine retinopathy of prematurity?

A

We measure PaO2, not FiO2. Keep between 40-60 mmHg

128
Q

Who is at greatest risk of absorption atelectasis?

A

Post-op, sedated patients, CNS dysfunction and retained secretions

129
Q

What is the normal values for PaO2 and PaCO2?

A

PaO2 - 80-100 mmHg
COPD PaO2 - 50-65 mmHg
PaCO2 - 35-45 mmHg

130
Q

What is the normal values for SaO2 and SpO2?

A

SaO2 - 95-100%
SpO2 - 94-100%

131
Q

CHART for PaO2

A

< 80mmHg - hypoxemia
>100 mmHg- hyperoxemia
80-100 mmHg- normal

132
Q

Hypoxemia classifications
Severe, moderate and mild

A

<40 mmHg - severe
40-59 mmHg- moderate
60-79 mmHg- mild

133
Q

What is the use of the capillary tube in a nebulizer?

A

The capillary tube draws up water and makes little particles from the velocity of the jet stream, similar to a diffuser in bubble humidifier

134
Q

What happens to the HR and RR in hypoxemia?

A

Increased HR and RR due to the increased work on the heart

135
Q

What effect does the peripheral chemo-receptors have on depression of ventilation?

A

Peripheral chemoreceptors are sensitive to a decrease in oxygen level

136
Q

What do we use for suspected carbon monoxide poisoning to measure the SpO2?

A

Co-oximetry

137
Q

What does a pulse oximeter measure?

A

the O2 in the blood carried by the hemoglobin (SpO2)

138
Q

How does pulse oximetry work?

A

Uses 2 light sources (red and infrared) that are absorbed in hemoglobin

139
Q

Can we use a pulse oximeter on a pulseless patient?

A

No

140
Q

Can anemia affect pulse ox?

A

Yes

141
Q

What should we do if we are unsure of the reading from a pulse ox?

A

Get ABG

142
Q

What should we always do first before anything else with an oxygen analyzer?

A

Calibrate to room air and 100%

143
Q

What has the biggest effect on accuracy with an O2 analyzer?

A

Altitude

144
Q

What effect does moisture have on an O2 analyzer reading?

A

It will cause the reading to be lower (condensation)

145
Q

What is the first thing we do when we are told a patient needs oxygen?

A

Check the order!

146
Q

Are cylinders used for large or small volumes of gas for home use?

A

Small (prevents waster of oxygen) and commonly used as back up

147
Q

What are the flow rates used with liquid O2?

A

1-8 L/m

148
Q

Do concentrations increase or decrease with higher flows from oxygen concentrators?

A

Decrease because there is not as much time for air to move through the sieves

149
Q

What device can you not use with an oxygen concentrator and why?

A

Venturi mask because of back pressure

150
Q

What are 2 advantages of home O2 concentrators?

A

They last a long time and don’t need refilled

151
Q

What is one disadvantage of home oxygen concentrators?

A

They are less pure so we may need to up the flow

MED GAS (1 decks)

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